Controlled Settings
by Beatrice Otter
Summary: The Joker, in Arkham.


Characters: The Joker, an Arkham psychologist

Word Count: 1220

Written for: my boyfriend on his birthday

* * *

Doctor Chandraskatta didn't bother to review his notes as the Mental Health Technicians—orderlies in all but name—escorted his patient into the treatment room. He knew what the notes said; he knew how little verifiable data was in there. He'd written most of it himself. The name on the file said "John Doe."

"Hello, Doc," the man who called himself "the Joker" said. "You're looking fit as a fiddle. Heard any good jokes lately?" He smiled in a manner calculated to enhance the look of the scar tissue around his mouth. His words were slurred, slow, hard to make out; a side effect of the medication they'd put him on.

"Yes," Chandraskatta replied. He changed the subject. You couldn't let someone with antisocial personality disorder control the conversation, and with the Joker that was even more dangerous than usual. "You were involved in the incident this morning between Singh and Hudson."

"Me?" the Joker said. His tongue came out, twitching, as it often did. "Oh, no, I wasn't anywhere near them when it happened. I was out in the hall, talking with my good friend Ramon."

"Don't you think that's a little disingenuous?" Chandraskatta said, raising an eyebrow. He noted the Joker's various tics once more. Tardive dyskenesia; some time in his life, the Joker had been on antipsychotics for a long time. Probably high doses, too. There should be medical records of him _somewhere_. "You were egging them both on all day. You'll never earn any privileges if you keep up with that behavior. And you'll be spending more time in solitary confinement. And your manipulations caused Singh and Hudson both to lose privileges."

"I'm not afraid of myself." The Joker waved a hand carelessly, scooting forward in his chair. Behind him, the MHT's tensed. "Are you? Might be nice, some time to myself, time to really be able to think. The boys on the ward are nice, you know, but a little … slow. All the meds. And really, it'd be a break in the routine. Same thing each day—meals, meds, therapy, all at the scheduled time. It's worse than working in an office cubicle, really." He gave an elaborate, exaggerated shudder.

"You don't like having a regular routine?" Chandraskatta asked. He leaned back into his well-worn arm chair, letting the familiar (if somewhat shabby) surroundings lend him—not _confidence_, exactly, facing the most notorious and vicious psychopath he'd ever treated—but comfort, a reminder that he was the one in control of the situation, however the Joker might try to twist things with his words.

"Routine, routine," the Joker said, leaning back in his chair, mirroring Chandraskatta's position. "Keeps you from thinking. Keeps you tied in to the status quo. That's why they're so big on routines here, you know. They give you purpose. I gotta get up today or I'll miss breakfast, and the whole world would fall to pieces if that happened. Get up, get dressed, go to work, earn money, spend money, take my place in the big machine, climb the ladder, pay bills, pay dues. You gotta ask yourself, why are you here?"

"You want to know why you're here?" It was a neutral question, reflecting the patient's concerns back at him. Basic counseling technique for a reason, Chandraskatta had found; sometimes sticking to basics got the best result, no matter what the young new doctors thought.

"No," the Joker said, smiling. "I want to know why _you're_ here." He pointed a hand directly at Chandraskatta.

"I'm here because it's my job to treat people with mental illnesses," Chandraskatta said. "_You're_ here because you killed a lot of people, and were found guilty by reason of insanity. If you ever want to get taken off restrictions, earn privileges, and maybe even get onto a lower-security ward, you're going to have to let me help you."

"If a guy's insanity is bad enough to get him on _this_ ward, he's generally well beyond any help _you'd_ ever be able to give him," the Joker said. "Me, I'm a psychopath, not a psychotic. Antisocial personality disorder." He rolled the words around in his mouth, savoring them. "I just really couldn't care less about anyone but me. It's a personality disorder, not a chemical imbalance." He shrugged. "You can pump me full of drugs to keep me stupid, talk at me all you want, but in the end, the only way I'm going to change is if I _want_ to do so. And all of your routines can't force me to want to join the great mediocracy. Makes your presence kind of pointless, doesn't it?"

"No," said Chandraskatta, not letting the Joker get to him. "I can't make you want to be healthy. But I can and do help those willing to work with me."

The session continued, full of the verbal sparring common to sessions with people diagnosed with antisocial personality disorder, particularly those of the Joker's intelligence. No progress was made, but Chandraskatta successfully parried the Joker's attacks, and perhaps gained a small portion of respect for doing so. It would have to count as a victory, Chandraskatta thought as he wrote up his notes on the session for the Joker's file. Given enough time—and time was one thing there was always a great deal of, in the highest-security ward Arkham had to offer—respect earned by refusing to pander to his whims might be enough to forge some kind of a true therapeutic relationship that might actually have some effect.

_Patient bears disfiguring scars on his face around the mouth area, perhaps contributing to his choice of pseudonym._

_Patient appears obsessed with both the precipitating cause and, to a lesser extent, predisposing cause of his disorder, repeatedly fabricating stories relating them to the scars around his mouth._

_Patient displays signs of tardive dyskinesia, indicating possible past treatment with antipsychotics over a long period of time. Patient displays no signs of clinical psychoses: no hallucinations (visual or auditory), no delusions, no disorganized thought patterns, no lack of insight into the patient's own abnormal behavior and thought patterns. Antipsychotics were probably prescribed off-label to combat patient's mood swings and personality disorders, but without medical records it is impossible to verify. Patient suffers from antisocial personality disorder._

_Patient appears to be intelligent and capable of organized thought, with a clear understanding that his thought and behavior patterns are unusual. Patient acknowledges himself as a psychopath. Patient is aggressively narcissistic,manipulative, lies habitually, is superficially charming, and appears to lack any remorse for his actions._

_Patient has precipitated several incidents between patients and between patients and staff. Patient mentioned disdain for routine and the possibility of help for his illness._

Chandraskatta paused, after finishing his notes, wondering what (if any) changes he should make in the patient's treatment plan. Perhaps he should hand him over to the new resident. It wasn't likely anyone would make progress with the man for some time to come, and transferring him to another psychologist might make him interested enough in Chandraskatta to listen, at some future date. And she had been asking for greater responsibilities. Besides, there were many patients on the ward with a greater need of (and use for) Chandraskatta's services. He added one last notation.

_Patient's therapy transferred to the primary care of Dr. Harleen Quinzell._


End file.
